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032-2050-80-000
o a) 0 o p vy N n s o 0 Co c u U N m i N C E i D O 00 � a J .+ a" CL x � � C O p C @ O v O C N N 3 ^ a� m o N I z `o o � C� m LL c c •y a N L ,C a 0 � a) a O E Q C H S U _N Q Q) � N E o Z 2- a CO 'o ', a m c ca o , c C7 o z d 4) Z c Z W F- a) E a � M C Y N • O _O a O m O Q Q w O = Z Z N z N N > N a .. c m 0 w o .. o G w c N LO Q G IL a o E c U) o O O O z •►rl m o a a a a E g ° n 0 0 0 0 N J V 3 rn 0) z N 0 QO O 1. .5 5 E (p LL S y N — \ Q Sf) i d .�- _ 7 50) LL �j O C ( m N C ►V +� O N Q O E o O 000 F" IO N C C U d o l V � _ l , N O a) a) y{ N M E il' N 0 �' Z` rIJI °) •�!1 �' MO (n Y a) O Fi N tn1 a �* a , • cl a m '� a) aar c `Fel E '� c A L) iL '' oinci Parcel #: 032-2050-80-000 02/21i2007 12:33 PAGE10F 1 Alt. Parcel M 14.30.19.688F 032-TOWN OF SOMERSET Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-KNEA, DONALD ET AL DONALD ET AL KNEA 205 WASHINGTON ST YOUNG AMERICA MN 55397 Districts: SC= School SP=Special Property Address(es): =Primary Type Dist# Description SC 5432 SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 14 T30N R19W 1 AC PRT GOV LOT 1 FROM Block/Condo Bldg: SE CORNER SEC 14, GO W 1745.1 FT, N 403.5 FT,TH NWLY 274.5 FT TO POB, TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NWLY 60.4 FT, SWLY 151.11 FT SELY ALG 14-30N-19W SHORE 61 FT NE 144.34' PER ASS'R/PROP UNDER WATER Notes: Parcel History: Date Doc# Vol/Page Type 12/29/1997 570455 1285/53 QC 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL I G1 1.000 16,000 12,500 28,500 NO Totals for 2007: General Property 1.000 16,000 12,500 28,500 Woodland 0.000 0 0 Totals for 2006: General Property 1.000 16,000 12,500 28,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 mm r W� KEEP CALM �Eiavr AM PIN: Person Requesting: Date: 3 Z �z ' Contact Information for Results: Ct ►'1 New Address: f t p , w. w: �s. d � x+ + 4 1 5 r. ol �r IZ a r" . Allow r e o- 4 I , R PUMP CHAMBER ufacturer: Liquid Capacity: Pump Mode Pump/Siphon Manufacturer: p Size . Elevation of inlet: Bottom of tank eleva Pump off switch elevation: Gall per cycle: Alarm Manufacturer: Alarm tch Type: Number of feet from neares property line: Front, S Rear,0 Ft. mber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Be Trench: Width: Len8fth: Number of Lines: Are -8trilt: Fill depth to top of pipe: Number of feet from nearest propert e: t, O Side, O Rear,0 Ft . Numb eet from well: • Number of feet from building: L (Include distances on plot plan). EPAGE PIT Size: Number of pits: Di er: Liquid depth: ttom o epage pit elevation: Area Built: Has either a drop or distribution box O been used on any of the above absorbtio tems? (Check one). DING TANK n Manufacturer: W f,l-5 r/'. Capacity: G L Number of rings used: Elevation of bottom of tank: Elevation of inlet. 9?f' Number of feet from nearest property line: Front, (QN Side, O Rear, Ft. IQ Number of feet from well: r Number of feet from building: 5 Number of feet from nearest road: �(3 Alarm Manufacturer: /A� /I PI/ 0 Inspector• ` '" Dated: Y7 Plumber on job: - r License Number: 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /(x )I OWNSHIP �i/`�jL ,SCT SEC. 1 T G N-R ` W ADDRESS ,4/?iV oC)0� ST. CROIX COUNTY, WISCONSIN 120 0.0 13 UP 14=1''ic% 5 S�� y o3 2— — S7t—f0,- SUBDIVISION Lt? fr.• C. LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 i I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1`J�t n y, C!�►�%�At 1J Q i J r � ^J I J34-:,O INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used JL,413 47- Elevation of vertical reference point: le0• Proposed slope at site: K: Manufacturer: Liquid Capacity: Number of rings use Tank manhole cover ele Tank Inlet Elevation: Tank Elevation: Number of feet from st Road: Front,O Side e feet m nearest- property line : Front-O Side,O Rear,O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION G.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SW,'4, SE%,S14,T30N—R19W ❑CONVENTIONAL ALTERNATIVE State Plan l.D.Number: Town of Somerset ®Holding Tank ❑ In-Ground Pressure ❑Mound ""8g7t'05591 Bass Lake NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Marion Potyondy ( 1116 Cedarwood Drive, Woodbury, MN 55125 9-d<.-,- S/,7 �Uv BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT.ELEV.: i ttl u Name of Plumber: IMP/MPRSW No.: County Sanitary Permit Number: Davin Schmitt 3205 St. Croix 99087 SEPTIC TANK/HOLDING TANK: (25 oro-I'Yv MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK O6LT+fi-rviv.: WARNING LABEL LOCKING COVER f y 91, 1 _ D E D: PROVIDED: q S °� YES ❑NO YES ❑NO BEDDING: J,VENT DIA.: VENT MATL.. HIGH WATER INUMSEA OF!— ROAD 1P ROPERT WELL BUIL ING: VENTTO FRESH ALARM: - j� / LINE:^ �, , AIR INLET. FEET FROM /fir �//, J.1` ❑YES O DYES ENO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: ILIQUIDCAPACIT PUMP MODEL PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES END DYES ONO GALLONS PER CYCLE: 1 MP D CONTROLS OPERATIONAL NUMBER jH" 'PROPERTY WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEE{FROM LINE AIR I"LET: PUMP ON AND OFF) J YES ❑NO NEARE51 SOIL ABSORPTION SYSTEM.Check the soil o s u a th depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wir ns ru tion shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. JNO.OF DISTR.PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID '.BE /TRE'M�ICH TRENCHES. MATERIAL: PIT DEPTH. GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL: BUILDING VENT TO FRESH BELOW PIPES. JABOVE COVER ELEV.INLET ELEV,END. PIPES: E.I.FROM LINE: AIR INLET: NEAREST----- -► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS 1-1 YES ❑NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED. CENTER. EDGES: El YES El NO 1 1:1 YES ONO 1:1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: 'JIIEOIFTRENCH WIDTH LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. QIMENS#ONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA,: ELEV.' PIPES. DIA.: 1 LEVATc A(%ID f0TRMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED 1NF(1RMATI4N PLANS DYES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF'. PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO E:1 YES 1:1 NO imeiFIEST 0 �3 U { j Sketch System on etain in county file for audit. Reverse Side. SIGNATURE. TITLE: Zoning Administrator DILHR SBD 6710 (R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must;tp approvep by the permit issuing authority. Anew ppr. Rit m4.1)e needed yt A if there is a change in your building plans, system idcation, estimated wastewater flow (nu`m e`r of bed' rooms, etc.), depth of,system, or type of system 4. Changes in ownership or plumber requires a Sanitor_y Permit Transfer/RendwaT Form (SBD-6' ) 'ode" submitted to the county prior to installation; , 5. Private sewage systems must be'properiy maintainetK\The septic tank(s) shouldtibC pemped'$y-a ticehsl d"` -' -- pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank.tnaterial. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate pre`ix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name i' applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h X 11 inches must be submitted to the county. The plans must include the following, A) plot plan,-drawn to scale or with eo4mp)ete dimensioans, location of holding tank(s), septic tank(s) or other treatment tanks' bdilding sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss,; pump performance curve; pump,model and,pump manufacturer; D) cross section,of the soil absorption system if required by the county; E),soil test data on a 115 form. -------------------- --------------------- --------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco IK3t can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T`ALre is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUN Y T DILHR In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERM IT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. ,j S?l —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION Se %,SE '/a, S IV T Q, N, R E(o PROPERR4 TY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME / CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK A_ IkTOWN OF*VILLAGE : M 11. TYPE OF B ILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. � Replacement c. El Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. )lIermit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. X Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet El Private ❑Joint ❑ Public VI. TANK CAPACITY Site in g allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ❑ ❑ El ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb Signature:(No Stamps /MPRSW N Business Phone Number: a c iT /S � - S Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(N tampsr f2i Sur r e Foe ea Approved ❑ Owner Given Initial O� 7 Adverse Determination .r X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may.be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed - if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)':o be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained`The septic tank(s) should-bibpamped•by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contactyour local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-381&. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; IL Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank`material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks,received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone numbe-. IX. County/Department Use Only; I,I X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 x 11 inches must be submitted to the county. The III plans must include the following: A) plot plan, drawn to scale or with cor plete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; ' C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and,pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ltei -- included the creation of surcharges (fees) for a number of regulated practices which Wisco tr 'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r @BSLtrQI is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY LJ w�LNF In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# i —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/z x 11 inches in size. 8705591 i —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION '/a '/a, S T D , N, R 1,9 (odp PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME E �` l CITY,STATE ZIP CODE PHONE NUMBER ED CITY NEAREST ROAD,LAKE OR LANDMARK Sd VILLAGE: �� fl. TYPE OF B ILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family, OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) II II 1. a. ❑ New b. Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. X Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑Seepage Trench c. ❑See age Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank 000 40,glsed ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb Signature:(No Stamps /MPRSW Business Phone Number: �, f Plumber's Address(Street,City,State,Zip Code): Name of Designer: i 1 �% 7 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber r Y y I Syr.t��' �M+�M+M�• to bye. AN If �{ !+ � j : �i-i+�' .✓7� � .� ,-,1��,.+�4 ilk' I� 1 t. t y .�,., # a,7�'f!�✓ ;�/n.+.�, t, ,N!//IR.V, '" }�t y` _ il�i� +4 -`+,'-+}'o*,.� .-r• . y / lR ii i t i R 1 k t� ,,r+- t .... wk i, �.. �.. its .� # •,� i yll'jS.l �' �' i c f 1 •r '� y� } ��� ' y �� N x "'" { 1 tr h 1 # 1 ? IWO t re A } � �y, - t � � ('�*C � Y .,� �� cx M. r• f 1 it l� .� � •i r:' ��j� Y {,� i �������'*"`�) � 'h�I I. i {-11 t - }� i E 1 a ,�. Y k `�nA^'•^�r�^�,. .' � �g�"'1'St'V ti � I �/ } I� } r rl r• l '1{ �f1���, + � C q. 1 r PI �� { PA rl �ww�:4�,+�Y1Al��I�r'i ► i..wrnwn Ir�.Wr.w��++w�rr!.......rMt^ ♦ A 2 f j� v. 4 � y. I tr c i .�� {, � � �-, �• ..,1 ��' rare �` �` , ,t 1" M i _ r t�s r r Ilk , r , r i VV , n 1 'DR tF - Fin.. f i•� � _ � � � 1 I`. � i l . r /�� �..�' ' ,• �- -� t q Zr WOOP 7 s»°'-, F.- •` fl L;f.7';� W f/.jIC.r f 'd { y, / ► ' �t r. t .r .j� " X r. .. L ' ,� ����" ••�y,(tail y t i � 1p� ; �>� r.t` Y v 0�~�� �� ' ������ 00 0� try. L2����[ and AU[M2nF�e|8tK]nS PRIVATE SEWAGE PLAN APPROVAL mAr s�Y&�umm���'v/mm�� Application ozv�sion n�eo 201 East Washington Avenue P.O. Box 7069 Madison, Wisconsin 53707 ST. CR0IX EXCAVATING Owner: MARION POTYONDY DONAVIN 5CHMITT ROUTE 2 1116 CEOARW0OD DRIVE SOMERSET WI 54825 WOODBURY MN 55126 RE: Plan Number: 87-05501—S Date Approved: August 81, 1987 Gallons Per Day: 150 Date Received: August 28, 1987 Project Name: P0TYONDY, MARION — RESIDENCE Location: SW,SE, 14,30, 10W Town of SOMERSET County: ST CR0IX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, The plans are ' stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans . All items that are noted must he corrected . All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department' s approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: — NEW HOLDING TANK Inquiries concerning this approval may be made by calling (608) 266-8230. Sinc rely, iv Se ion of Private Sewage Division of Safety and Buildings � PPP016/0009n/15 cc: MARION POTYONDY Private Sewage Consultant County ___UW—SSWMP ___Plumbing Consultant --- ___Plum6er ___Environmental Health N o/L*n-Soo'**23(w.0*m1) N f, r 31P 04:04 Co t!f rca C a co z 30 is tva •� 44 v tq# so a 44 yy '•• •• 1■A CJ 40 y • w tea. + a yr 410 29 $ . es 0 NO on ei f a► y +� , 09 4 IV b cr w. - lil W r'!♦ x -..1 �. RR •.r Y L^ K b M• Or• PI >!., tAa M ei t, M ry, 0 h ��� '� 5 F ago If 171 4tq C!4�' o. P� - rO•o ~o w � � �� � Ya p m n 0 fN w Q a 41C :is y M: i P7„lr lot n ---- A q X11 � M d ^►�f f `4 � ►•n x a i. � •� fir'�` 4.� � � ro � ( r raM• `•i tit I 'at,'. i (p Rx o W 44 r r'. C7 d!R 9 M • ara n •arsca �e . . $14nC) LNG 994 29 39 7d t" 11 In PC to ® •s as cn •e ° • A� .. •• NCflco (A � • aw ,r;� •10 1•f •• a ..~ t1=+ .5 C � n X. ...: • � O so z SN 1A n H •• } IIA � •• H H p• � � p � 5 �* f ao n►a+w oo a O a Y o Oi IV yy d 1+ K O HG■iA • O ` gyp a � � 0 f! o o N N w r p 0 7 t r 1 • � N a� K A x ! n I e1C Qj y a y ®� A n' O •-� e s N `S� M d• sf A O n x O O A d. i < r yr vs o ►.r . .°. ag•o —0. rl s f A A � »~ $ C Vd iV^ _ to to b uf Oa • 1"{ b O . b Q N A N O 6 4 UA w O w O r b N w vs e. n s � w i m n \ � b ' Io r n Q DID ro p sr-1 -+ r 0 0 a • sc• "'n� 11 o r • R w • r = r,.-0 •nu f.f n s a 7t n M1 r C y. f• •C�f�a.H� PRIVATE SEWAGE SYSTEMS WI ON OWSICkFIITY&BUILDINGS BUREAU OF PLUMBING PLAN APPhOVAL APPLICATION 1201 E.Washington Avenue,Rm 741 P.O.Box 7869,Madison,WI 53707 608-268-3815 IIrIST'RUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales,202 South Thornton Ave.,P.O.Box 7840,Madison,Wisconsin 53707,Telephone(608)266-3358, 1. PROJECT INFORMATION(Type or print de ly) Revision To Plan Number: + i Name of Submitting Party(Plans returned to same) Project Name 7y Street 8 No.or Rural Route Project Loca on'-Street 1£No.or Legal Description City or Village State Zip City County � Villa a OF: n 7pri .. Tow, 5 L T Telephone No.(Include area code) Designer Telephone No.(Include stele code) Owners Name telephone No.(Include area code) r�G/f/`�/P/ ___- �i Street 8 0. tree &No.� __L r p , Gity o Village State Zip ity or Village State Zip r 2. APP ATION FOR: New Mound System(3af Groundwater Monitorinig(7) M Conventional System-Public Building(1J Replacement Mound(4a) Holding Tank(2) ❑Replacement Pressurized System(4b) System in Fill(1) Petition For Variance(6) ❑New Pressurized System(3b) System in Flood Fringe(1) ❑Other Alternatives(5) 8. FEE COMPUTATIONS(Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank - 50.00 " 4a. _ 3b. 1,501- 2,500 gallon septic tank - 60.00 4b. 3c. 2,501- 5,000 gallon septic tank - 80:00 4c. 3d. 5,001- 9,000 gallon septic tank 100.00 4d. 3e. 9,001 15,000 gallon septic tank -150.00 4e. _ 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500- 1,000 gallon dose chamber - 30.00" � 4g. 3h. 1,001- 2,000 gallon dose chamber - 50;00' 4h. _ 2,QQ.1. 4,000 gallon dose chamber - 70.0 •, 4i. _. 3j. 4,001- 8,000 gallon dose chamber - 90.,00' 4j. 3k. 8,001 - 12,000 gallon dose chamber -110.00 4k. 31. Over 12,000 gallon dose chamber -150.00 41. , 4 - -5�0 .5,000 g�tUou hQldi:ng tank - 30.00 4m. 3n. 5,001-10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank -100.00 4o. 3p. Revisions - 20.00 4p. _ 3q. Groundwater Monitoring Per Lot - 32.00 4q. _ (other than a proposed subdivision) Subtotal 3r. Priority plan review:walk through 4r. Submittal of plaps in person, , by appointment;with double fee 4 3s. Petition for variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee NOTE:Fees pursusni to Wis.Adm.Code,Chapter Ind.69 SBD-6748(R.8/65) may be subject lo change annually EMective July 1,1984 -OVER 798-2239(MAMMQND) 425-8383 (RIVER FALLS) HAMMOND, WI 34015 July 28, 1987 Division of Safety and Buildings Office of D vision'Codes And Ap' lic:,tioli P.O. Box 7969, Madison, WI 53707 Dear Sir: An on site investigation of the Marion Potyondy residence located in the. SA of the M4 of Section 14, T30N-R19W, Town of Somerset, St. Croix County, indicated that ground water is within 6 inches of the surface of the ground. This site should be suitable for. a Bolding Tank. Should you have any questions, please feel free to contact this office. Sincerely, l < Thomas C. Nelson Zoning Administrator TCN/rc I osS 1 AUK 4W ,981 A�l lA ITTE OF MM OIL"" ? N � M uw a piI WWI"+ a ,� ,� �` 4, �A,INEAU:t1F'PL,1>IIMtMINO , 'Aft�.t VAL AP�UCATI©N ex swaaltlon Atrinue,rent t4� Tom,tYla�eo n,WI �Sfiiyi Please fill In`atl appllgebler.+d$ta iaind ey t I ! firm with plans.. Plans,will not be reviewed.dntil all fees are received, The balck hide tttia farm`dest:ribea requirl plan ntorttutJit4 ,��utrtbing codes can be purchased from the Department A�. piniatra3#on, i r ere nips,2( Soti#h Thornton Avp.,P,Q.8 ox78dQ, ;'Wisconsin;537Q7,Telephone(608)266-3358.', 1. 7 Tll+llaQgMATI m{T9pe or Pont >E) 4 Revision To Plan Number. Na 7te Q m inp satiny $ at ad to same) z •' Propvt Name Su"aii't f1 fop;onM�4ra1 Route ,� Projk•c.t Loca on-Street&No.or Legal ,ai�w 'sIl Deltcrtption C.ity�q�t/iitatye.E EX state • "� 5.-..Zo -49 City' County Ville To aye a o,j nctuge area code); . d ` l� sig/tet '� et e. Qwner Nam s 0 Tale phones pia,(IptoWdr+araats� t ebb a �E treet& c h.A i a S ), City or Village to ., w r� Fla *w Mound System(3a Ciroundw>et r R tt orinl0(T) onel System ;public.86lit�in eplacement Mound(4a) Holding Tank,of Pr6► uriZ�tdSyst�m #b y�tem in Fill(1) Petition i�px AlaFiellht�pe(6) etl(t(3b) 9 ° stem in Flood Fridges(1) 4�Ifter Alt ; ) VITA IBS(ITtcltlde ex hNn low "� FEE SUB�IFITTE#) I I-' CK$PAYABI. Tp QIiR ` �x .. ♦ s y3�8i i . ' ..1 i IiFsli#bn. �ptictt#r?�4 , aa. 9"li �'aT ',I"M tMf 46, F S y� t ¢ lye f yr�y ga MM+ � i !'r '+i7tl,ui► Y`Iw•t! i ' „j �'' rR# oali4rtaticitic, c ids'f "F”�1 r ��., 'a,,.. tftic tank +4f. g i'x�o$lttton dot6e Ci? R�1 Ir I�t{y �E1,aj�Y11. F ejU r Q 4�QW061lon pseal ihr '+ 4v. l ' 1 ,k1 giion.dcse ce w E• aj. _ i4 001U a 112,tlgQ g 1 Of!dose c to miler 1 fi °' 4l�. ' 31 oval„tl,iygp g�lon,dtise chaltritaeter �`1� �` �° .,9i. � + ,`' #`• i n +P r�' }ILQR-ti niC y M. So ' 4uet ,f1$aIlon>lotdirl tl#!k f +10. a . , 3p, r � i i ti at Mtrnitor ng Peer t "�” T (o-than a popas ,Stab d bin � etaI plan review:walk thrt9tgtt ' 3r Pi ri 4r. 4 Sy�rttiftal(if p S in pwerhAn� �,tntfr'I�t� r s 4Y� .for � ' � 'k§ESi� i ��,� ? ✓ � "� Gift )d� #t#,,Ovalltation Fr3e _ NO Adm.OWO,Chapter W.6e 5� 1� t td ehatagdt a,pivaNy ,ruts�,teal -OVER aSPibS r/ .Scale �ross secf�on of�.re�ose� w T fa< lot area / 3(oa ro oseu N ass 0Spff `Ip :� are¢ Bass Existc'nj 9,,adc -C t rar 7pl/i".w comer • • w I •�� ' pro •sea� 4r as-ess � -, ufll�ty slsed , I u: ZLtz Cz�7 P!e ��` � PT"p�oseGL a�^ell �or ,� � •►� .� �000�yul. f�l�n� �an.� Is�z a c�ecl are e4 . � 1115•1210oseal ar Pa fo �e • D���e`"' 7`c�l(e Gl wc`f� a��r ox c'm aZ�e`� ' .3 ' of ar,�rov eCl ftll � w w �� x�stin9 rz Cone 6ec�ruom� F •stz: /15�12-t,os eal rr� �►a�a of 4roved ��� / _.. roc.�c oYer (�.�var �rouna/ coyer• too 6e �y,anz<<+ !y laced 6 0 l e'n e a s o f ,4,,p,- ( /B, /986 LccazLion I 5W� oftI,e SE% QfSection 14, 7-30N-R/9 W, 7owrr of Soirersct July 13, 1987 DI LHR Buren+,x of Plumbing F. n. Fox 7969 Madison, Wisconsin 537G7 Attention: Plan Review This property has received a violation notice from St. Crotx County Zoning. The property owners ri �vo ap,;lird for -- rd received ti-a proper perm- its to improve t1eir prorrTrt%r. The holding.- tank is the last item to ->e taken care o '. Ina luaed; Gop:T Shli 6396 it j LL; 6123 ti SBD 7574 I,ot improvement '1&r tr Holding Tank Plot Flan Oheck for V24.uu Flan ;tevi_ec� Thank you Donavin L. Schmitt XPRSW #3203 ST. CROIX COUNTY WISCONSIN }" ZONING OFFICE 798-2239 HAMMOND 425-8363(RIVER FALLS) HAMMOND, Wi 54015 July 28, 1987 Division of Safety and Bui-Idings Office of Division Codes and Appl i,c-tio.. P.O. Box 7969 Madison, Wl 53707 Dear Sir: An on site investigation of the Marion Potyondy residence located in the SW's of the SEA of Section 14, T30N-R19W, Town of Somerset, St. Croix County, indicated that ground water is within 6 inches of the surface of the ground. This site should be suitable for a.'Holdi.ng Tank. Should you have any questions, ploa:;e feel free to contact this office. Sincerely. Thomas C. Nelson Zoning Administrator TCN/rc I i State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION July 20, 1987 Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ST. CROIX EXCAVATING Owner: MARION POTYONDY ROUTE 2 1116 CEDARWOOD DRIVE SOMERSET WI 54025 WOODBURY MN 55125 RE: Plan Number 87-05591—S Project: POTYONDY, MARION -- RESIDENCE County: ST CROIX Location: SW,SE, 14,30, 19W Fee Received: 24.00 SOMERSET Date Received: 7117187 This letter is to acknowledge receipt of the Plumbing Plans which you submitted to the Safety and Buildings Division, Bureau of Plumbing. We cannot however, process your submittal until we receive: — A completed approval application with the owners complete, current and correct mailing address. — Reason for installing holding tank. A copy of soil boring and percolation test data by a Certified Soil 'Tester on a 115 is needed or a written inspection report by the county is required. — A system plot plan showing the following: — An all.—weather service road within 10 feet from all holding tank manholes. Additional information requested shall be properly signed as per Section ILHR 83.08 (2) (a) . All information requested shall be submitted in duplicate unless otherwise specifically noted. Please retain one copes of this letter for reference and return the other with the materials reaues-ted. Your Plans will be processed within 15 days by the Bureau of Plumbing following receipt of the requested items. Petitions or plans submitted to this office which require additional information will be held 90 working days for receipt of the information. If, after 90 days, response to this letter has not been received, your plans will be returned. If you find it necessary to contact us regarding your submittal, please call us at (608) 267-5119 and refer to the plan number as shown above. DILHR-SBD-6423 (N.04/81) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION ST. CROIX EXCAVATING Page 2 July 20, 1987 Sincerely, 0" C C Q"t� ANN E. ADDIS Section of Private Sewage Division of Safety and Buildings PAC017/0001n/14 COMP: 12 ELEM: 10 cc: MARION POTYONDY � County Plumbing Consultant Local PI _Plumber Environmental Health _.—Facilities Need Analysis Section T�UW—SSWMP M__._Dept of Agriculture Private Sewage Consultant HR-SBD-6423(N.04/81) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION August 17, 1987 Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ST. CROIX EXCAVATING Owner: MARION POTYONDY ROUTE 2 11.16 CEDARWOOD DRIVE SOMERSET WI 54025 WOODBURY MN 55125 RE: Plan Number 87-05591--S Project: POTYONDY, MARION — RESIDENCE County: ST CROIX Location: SW,SE, 14,30, 19W Fee Received: 30.00 SOMERSET Date Received: 7/17/87 This letter is to acknowledge receipt of the Plumbing Plans which you submitted to the Office of Division Codes and Application, Section of Private Sewage. We cannot however, process your submittal until we receive: — Please use the inclosed profiles when useing 2 tanks. Your plot plans show only 1 tank please submit new plot plans that show 2 tanks. How many bedrooms does the cabin have? Additional information requested shall be properly signed as per Section ILHR 83.08 (2) (a) . Unless otherwise specifically noted, please submit two copies of all requested information. Please retain one copy of this _letter for reference and return the other with the materials requested. _ Your, Plans will be processed within 15 days by the Section of Private Sewage following receipt of the requested items. Petitions or plans submitted to this office which require additional information will be held 90 working days for receipt of the information. If, after 90 days, response to this letter has not been received, your plans will be returned. If you find it necessary to contact us regarding your submittal, please call us at (608) 266-8230 and refer to the plan number as shown above. 0ILHR-SBD-6423 (N.04/81) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION ST. CROIX EXCAVATING Page 2 August 17, 1987 Siric ely, E ETH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0001n/ 2 COMP: 12 ELEM: 10 cc: MARION POTYONDY _County Plumbing Consultant Local PI _ Plumber _Environmental Health Facilities Need Analysis Section UW—SSWMP Dept of Agriculture _____Private Sewage Consultant DILHR-SOD-6423(N.04/81) t� Document No. This space reserved for recording data HOLDING TANK AGREEMENT Agreement Date 7 This agreement is made between the County or Local Governmental Unit I H (ding Tank(s wner(s) �r f_Te E he) sirarn ,ST G r'O I X I P0,111 nqa DonGAd (Called Municipality below) I Metrion e We acknowledge that application is being made for the installation of( holding tank(s)on the following property,(Provide legal land description:) _1 __-o >h- Return To or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83,Wis.Adm.Code,or Ch. 145,Stats. As an inducement to the County of __Isf G ro l to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83,Wis.Adm.Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Stats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s.66.60,Stats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection,pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty(30)days from the date of notice. In the event the owner does not pay the costs within thirty(30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance,and the tax shall be collected as provided by law. 3. The owner,except as provided by s. 146.20(30)(d),Stats.,agrees to contract with a person who is licensed under Ch.NR 113,Wis.Adm.Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county.The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten(10)business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch.NR 113,Wis.Adm.Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20(3)(d),Stats.,the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83,Wis.Adm.Code. In addition,this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner,the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s)Name(s)(Print) I Owner(s)Signature(p) Gq _ 15 '0-1 ____I w� � ,.G�Jt��_.. ....._.___ Subscribed and sworn to before me on this date: AhArl I Municipal Official Nam (Print) I Municipal Official Signature Notary Public My commission expires: ��l I Lt Q 1V �V� IV Municipal Official Title(Print) SBD-6123(R.10/85) This instrument was drafted by the State of Wisconsin Department of Industry,Labor and Human Relations,Bureau of Plumbing. t/ HOLDING TANK SERVICING CONTRACT C ct Dat .Aip This contract is made between the Holding Tank Owner(s)Name(s)< and Pumper's Name g&il We acknowledge the instal ation of ) holding tank(s)on the following property: (Provid egal description:) IN C 2C&U 6k) T 3 0 AJ r 1. The owner agrees to file a copy ofthis contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b),Wis. Adm. Code and with the County of C--:)r (� r o 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement wil! remain in effect unti! the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s)Name(s)(Print) I Owner's Signature(s) ��zo tfG �hnsfrnm i. Subscribed and sworn to before me on this date: Sept em , 1986 i 96n Oki pot ands Pumper's Name(Print) Pumper's Signature Notary P, is My commission expires: �vu�ers 4 c Novembers 24, 1988 Pumper's Registra i n Number SBD-75 (N.11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. r tn H a STC - 105' r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z cy a H OWNER/BUYER Donald Knaa aeor�gett"s Ehnqtrnm, Bill Knea, Marion Fotyondy ROUTE/BOX NUMBER Mailing address Marion Potyond ire Number 2- 1116 Cedawood Drive .CITY/STATE Wnnri nr;r MN ZIP 5513K_7f1�}'L_ PROPERTY LOCATION: SW JX, SE ;4, Section 1.4 , T '10- N , RAW, Town of Somerset , St . Croix County, Subdivision W, P'ti, Oa J. 1 Lot number .689'' . Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic *tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x M the standards set forth, herein, as set by the Wisconsin Depart- 'v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offiyce within 30 days of the three year expiration date. SIGNED DATE May 30, 1987 St . Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DOCUMENT NO. QUIT CLAIM DEED VOL 573 `i �"�8 STATE OF WISCONSIN.-FORM 11 f d THIS SPACE RESERVED FOR RECORDIRB DATA 348278 REGISTERS OFFICE THIS INDENTURE,Made this 3rd day of ST. CROIX CO, Wis. ! A. D., 19 78 ,between GEORGE W. KNEA and EVELYN W. 3A, ius and wife as joint tenants with right of survivorship, Rec'd. for R=rd fNs_ 3rd day of Matey A.D. 79.20 0_ at ti part ies of the firstyart, and _1 DONALD I,. KNEA, GEORGETTE. EHNSTROM, WILLIAM KNEA, anc MARION POTYONDY, as tenants in common e0 o Nds part iaii__of the second part. RETURN T 0 W i t.n e s si e_t h, That the said part ies of the first part, for and in consideration of the sum of no consideration paid — between parents & children Dollars,to them in hand paid by the said part ies of the second part,the receipt whereof is hereby confessed and acknowledged,ha ye_ given,granted,bargained,sold,remised,released,and quit-claimed,and by these presents do give, grant, bargain, sell, remise, release and quit-claim unto the said part ies_of the second part,and to the;]heirs and assigns forever,the following described real estate,situated in the County of St. Croix and State of Wisconsin,to-wit: A part of Gov. Lot 1, Section 14, T 30 N, R 19 W, St. Croix County,. Wisconsin, further described as follows: from the southeast corner of said Section 14, go due west a distance of 1745.1 feet, thence due north a distance of 403.5 feet, thence North 520 28' West a distance of 274.5 feet to point of beginning for parcel to be conveyed herein; thence North 520 28' West along the south line of the Town Road a distance of 60.4 feet, thence South 270 46' 'West a distance of 151.44 feet, thence South 460 59' Easton a meander line on the shore of Bass Lake a distance of 30.6 feet, thence South- 710 47' Easton a meander line on the shore of Bass Lake a distance of 30.4 feet, thence North 270 46' East a distance of 144.34 feet to point of beginning, together with all land lying between said meander lines and Bass Lake. Surveyed March 18, 1960 EEE EXEMPT Send Tax Statements To: Donald Knea Box 315 Young America, Mn. 55397 To Have and To Hold the same, together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the said part ies of the first part,either in law or equity, either in possession or expectancy of, to the only proper use, benefit and behoof of the said part ies of the second part, their heirs and assigns forever. In Witness Whereof,the said part ies of the first part have hereunto set their hand S and'seal s this 3r day of May , A. D., 19 78 . SIGNED AND SEALED IN PRESENCE OF _%_L��EAL) eorge nea ve yn nea (SEAL) (SEAL) (SEAL) STATE OF WISCONSIN, 1 } _ St. f:roix County. ss.J Personally came before me, this 3rd day of May ,A.D.,19 78 , the above named _ George W. Knea and Evelyn Knea, husband and wife, to me known to be the persons—. who executed jt,4okeibjm nstr"'igent and ck owledged,the sarrLe. • t7 N.: lamas ntibnnell LIC NKTAU-i r' 'SEa4L This instrument drafted by J' = _7 Notary Public St.. Croix County,Wis. Robert A. Nicklaus Law Firm 'r 55318 Box 208, Chaska, Mn. ' ��.� ` My Commission (Expires) ( )_�11ay - 1�— (Section 59.51 (1)of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors grantees,witnesses and notary). QUIT CLAIM DEED—STATE OF WISCONSIN.FORM NO.11 r APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property G e�;Cggtte Lhnstr©m;. Bill Knear,, Marion Rbtyondy Location of Property X14, Section I"' , T_ 'gip N-R 9 W Township Somers' ` Hailing Address Mari nn Fr t;rnr`A•3r-� 1 �= c� �w�d- y�ncue �fi .�. * Address of Site Subdivision Name _ Pt r.- Lot Number 688Z' Previous Owner of Property G nr ge nnc3 &AI yn Knan Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes No Volume 5 — and Page Number 278 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (eve) eeAti,6y that att 6.tatement6 on thi.6 604m ahe tAue to the but o6 my (ouh) knowl-edge; that I (we) am (cue) the owner(6) o6 the p topeh t y deb cA i.b ed in th,i.6 .in 600 Won 6oAm, by ViA tue o6 a wahAan ty deed recorded in the 0 6 h.ice o6 the Cowry Reg.id,teh o6 Veedbas Voeument No. 348278 ; and that I (we) pnesentCy own the phopo6ed bite bon the 6ewage di,spob 6y6 em (on I (we) have obtained an eaaement, to nun with the above deacA bed pnopehty, bon the con,6tAuction o6 aa.id 6y6.tem, and the Game has been duty keeakded in the 066.iee o6 the County Reg.i,6ten o6 Veed6, a6 Uoeament No. ) . 72 iou aAhw�,/ SIGNATURE Oh OWNER 0 SIGNATURE OF CO-0 ER (IF APPLICABLE) May 30, 1987 'tau o 1987 DATE SIGNED DATE SIGNED